"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

In doing my research, I came across aspirin therapy studies that should be of interest to women.

Another Example of Gender Bias

One research study found that women were more likely than men to receive inappropriate aspirin therapy.

Another study spanning 15 years followed nearly 28,000 women taking aspirin for primary prevention of cardiovascular disease (CVD). The findings? For most women the benefits of aspirin did not outweigh the risks of bleeding complications.

The researchers concluded that aspirin “is ineffective or harmful in the majority of women with regard to the combined risk of cardiovascular disease, cancer, and major gastrointestinal bleeding.”

But it’s not just A-Fib patients who shouldn’t be on aspirin therapy for stroke prevention.

Data indicates more than 1 in 10 patients take aspirin when they shouldn’t.

Warn your family and friends who are taking daily aspirin for stroke risk: Maybe they shouldn’t be.

Aspirin 3D model

50 Million in the US Take Aspirin for Prevention of Cardiovascular Disease

The problem with routinely taking aspirin is an increased risk of bleeding complications. More than one-third of all adults in the U.S. are now taking aspirin for primary and secondary prevention of cardiovascular disease (CVD).

“Primary” means preventing a first event like a heart attack. “Secondary” means preventing a reoccurrence of an event, like a second stroke.

When is Aspirin Therapy Appropriate?

As a “primary” prevention, only patients with a moderate to high 10-year risk of cardiovascular disease and stroke should be on aspirin therapy (estimated using the ACC/AHA risk-prediction calculator or similar calculator).

When is Aspirin Therapy Not Appropriate?

Aspirin is not appropriate for people who are at low risk—defined by their 10-year risk score. For these people, the risks of gastrointestinal bleeding and hemorrhagic strokes outweigh any potential benefit. “Among the more than 16,000 deaths each year linked to bleeding…, about one-third of these deaths occur in those who take low-dose (81-mg) aspirin.” The FDA in 2014 released a statement that warned against widespread use (of aspirin) in people of average risk.

Like Other Blood Thinners, Aspirin is a Pharmaceutical Drug

It’s all too easy to take an aspirin―we don’t need a prescription to get it. But taking an aspirin isn’t like taking a vitamin. Aspirin is a pharmaceutical drug.

Instead of routinely taking aspirin, you should discuss aspirin therapy with our doctor just as you’d do for any ‘by prescription’ blood thinner. (Take along a copy of this post.)

Note: Suddenly stopping daily aspirin therapy could have a rebound effect that may trigger a blood clot. If you have been taking daily aspirin therapy and want to stop, it’s important to talk to your doctor before making any changes.

“Many patients with atrial fibrillation may be taking aspirin because they think it is ‘good for their health,’ said Dr T Jared Bunch of Intermountain Medical Center, Murray, UT. “But if they are not taking it for a prescribed reason (because they have CAD or a stent), they should stop taking aspirin because it adds risk over time.”

Aspirin is no longer recommended as first-line therapy to prevent A-Fib stroke.

It’s amazing how many of us have been convinced to take a baby aspirin daily to improve heart health and to prevent a stroke (myself included).

Taking an aspirin isn’t like taking a vitamin. Aspirin is a pharmaceutical drug.

We now know we are risking tearing up our stomach with GI bleeds and developing a hemorrhagic stroke.

It’s all too easy to take an aspirin―we don’t need a prescription to get it. But taking an aspirin isn’t like taking a vitamin. Aspirin is a pharmaceutical drug.

photo by holohololand

Discuss Aspirin Therapy With Your Doctor: You should discuss aspirin therapy with your doctor just as you do for any other (by prescription) blood thinner. You might want to take along a copy my AF Symposium report, AHA/ACC/HRS Treatment Guideline Changes.

Note: Suddenly stopping daily aspirin therapy could have a rebound effect that may trigger a blood clot. If you have been taking daily aspirin therapy and want to stop, it’s important to talk to your doctor before making any changes.

16. “I’ve had a successful ablation. For protection against potential stroke risk if my A-Fib re-occurs, which is better—81 mg baby aspirin or 325 mg?”

With respect, the question you should be asking is, “Why am I still on a blood thinner if I’ve had a successful ablation and have no signs of A-Fib?”

It’s normal after a successful Pulmonary Vein Ablation (Isolation), for doctors to keep you on warfarin (Coumadin) for three to six months while your heart heals. Re-growth or re-occurrence of your A-Fib is less likely to occur after six months.

Potential re-growth or recurrence doesn’t justify the associated risks of keeping a patient on warfarin.

Potential re-growth or recurrence doesn’t justify the associated risks of keeping a patient on warfarin.

Once you’ve had an ablation, your stroke risk drops down to that of a normal person. This doesn’t mean you will never have a stroke. People in normal sinus rhythm (NSR) do have strokes. But because you had A-Fib in the past doesn’t mean you have an increased risk of stroke now that you are A-Fib free. As Dr. John Mandrola says, “And if there is no A-Fib, there is no benefit from anticoagulation.”

In general you should know that aspirin is not very effective in preventing an A-Fib stroke (post-ablation or not).

A research study found high-dose aspirin was associated with a nearly threefold increased risk of major bleeding, particularly within the first two months, but also over the entire three-year follow-up period of the study.

Aspirin is not very effective in preventing an A-Fib stroke (post-ablation or not).

Aspirin also causes stomach ulcers in 13% of those using it. And these ulcers usually develop without any warning symptoms. Many of these ulcers will cause a serious stomach bleed at some point. Also, taking low-dose aspirin on a regular basis more than doubles your risk of developing wet macular degeneration. On the positive side, people regularly taking low-dose aspirin have a significantly lower chance of getting cancer.

What this means to you:You may want to talk to your doctors about your post-ablation risk of recurrence and why you are taking aspirin if you no longer have A-Fib. If you have other high-stroke risk conditions, and a blood thinner is called for, you should discuss the problems associated with aspirin.

Added 8/10/15. Aspirin is no longer recommended as first-line therapy:

Aspirin has been downgraded from class 1 in the 2006 guidelines to class 2B in the 2014 guidelines.

In a Danish registry study, aspirin didn’t show any benefit for stroke prevention.1And in the European ESC guidelines, aspirin is not recommended as first-line therapy for patients with a CHA2DS2-VASc score of 1.2

Camm, AJ et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. EUR Heart J 2012;33:2719-47↵

Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

FAQs A-Fib Treatments: Medicines and Drug Therapies

Drug Therapies for Atrial Fibrillation

Atrial Fibrillation patients often search for unbiased information and guidance about medicines and drug therapy treatments. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)

16. “My doctor has me on aspirin for stroke prevention. Which is better—the low-dose baby aspirin (82 mg) or a high dose (325 mg)? Also, should I take the immediate-release (uncoated) or the enteric-coated aspirin?”

See August 2015 update below.

The HORIZONS-AMI study found that patients on high-dose aspirin had higher rates of major bleeding than those on low-dose aspirin. And the high-dose aspirin didn’t provide any additional protection against ischemic stroke.

High-dose aspirin was associated with a nearly threefold increased risk of major bleeding, particularly within the first two months, but also over the entire three-year follow-up period of the study.

Realize that aspirin is not very effective in preventing an A-Fib stroke.

If you have to take aspirin, this study indicates a baby aspirin is preferable over high-dose aspirin.

Also, uncoated aspirin is generally better. In a study measuring aspirin absorption, half the subjects didn’t fully absorb the coated aspirin within eight hours, but all absorbed the uncoated aspirin. And “coated aspirin has never been shown to reduce bleeding in the stomach.” (Since almost all baby aspirin is coated, chew it before swallowing to remove the enteric coating.)

August 2015 Update: Aspirin is No Longer Recommended as First-Line Therapy

Aspirin is no longer recommended as first-line therapy for Atrial Fibrillation patients according to the 2014 AHA/ACC/HRS Treatment Guidelines for Atrial Fibrillation. Though not a new finding, it should be noted that aspirin has been downgraded to class 2B drug.

A similar directive is included in the 2012 European ESC guidelines for the Management of Atrial Fibrillation: aspirin is not recommended as first-line therapy for patients with a CHA2DS2-VASc score of 1.

Aspirin is not appropriate for people who are at low risk of cardiovascular disease and stroke. For these people, the risks of gastrointestinal bleeding and hemorrhagic strokes outweigh any potential benefit.

When is aspirin appropriate? Aspirin is recommended for “secondary” prevention of cardiovascular disease such as reoccurrence of a stroke or heart attack.

8. “I’m on warfarin. Can I also take aspirin, since it works differently than warfarin? Wouldn’t that give me more protection from an A-Fib (ischemic) stroke?”

No, combining is dangerous.

Preliminary research indicates that combining anticoagulants (warfarin) and antiplatelets (aspirin) in the same patient is associated with a substantially higher risk of fatal or non-fatal internal bleeding.

There’s no indication that combining warfarin with an antiplatelet (aspirin, clopidogrel, or both) reduces the risk of ischemic stroke.

Added 8/10/15. Aspirin is no longer recommended as first-line therapy:

Aspirin has been downgraded from class 1 in the 2006 guidelines to class 2B in the 2014 guidelines.

In a Danish registry study, aspirin didn’t show any benefit for stroke prevention.1And in the European ESC guidelines, aspirin is not recommended as first-line therapy for patients with a CHA2DS2-VASc score of 1.2

Camm, AJ et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. EUR Heart J 2012;33:2719-47↵

6. “Which is the better anticoagulant to prevent stroke in atrial fibrillation patients—aspirin or warfarin (Coumadin)?”

See August 2015 update below.

People with less risk factors for stroke are sometimes put on aspirin. People more at risk for stroke such as those over 65 years old with frequent A-Fib episodes are often on warfarin (Coumadin) (baring other risk factors such as peptic ulcer, etc.).

Aspirin and warfarin work differently.

Aspirin is an antiplatelet drug that decreases the stickiness of circulating platelets (small blood cells that start the normal clotting process), so that they adhere to each other less and are less likely to form blood clots.

Whereas warfarin (brand name Coumadin) is an anticoagulant that works by slowing the production of blood clotting proteins made in the liver.

Current research indicates that aspirin is not as effective in preventing blood clots (and therefore, strokes) as Coumadin.

Current research indicates that aspirin is not as effective in preventing blood clots (and therefore, strokes) as Coumadin. “Warfarin is highly effective, reducing the annual risk of stroke by approximately two thirds; Aspirin has a more modest 20% effectiveness rate.” But aspirin is less likely to cause abnormal bleeding than warfarin.

Younger people with a low risk of an A-Fib stroke “appear to derive little benefit from warfarin. And, indeed, warfarin may do more harm (intracranial hemorrhage) than good (prevention of ischemic A-Fib stroke).”

Bottom line: Weighing the various risk/benefit ratios is a decision for you and your doctor and may change as you grow older.

August 2015 Update: Aspirin is No Longer Recommended as First-Line Therapy for A-Fib

Aspirin is no longer recommended as first-line therapy for Atrial Fibrillation patients according to the 2014 AHA/ACC/HRS Treatment Guidelines for Atrial Fibrillation. Though not a new finding, it should be noted that aspirin has been downgraded to a class 2B drug.

A similar directive is included in the 2012 European ESC guidelines for the Management of Atrial Fibrillation: aspirin is not recommended as first-line therapy for patients with a CHA2DS2-VASc score of 1.

Aspirin is not appropriate for people who are at low risk of cardiovascular disease and stroke. For these people, the risks of gastrointestinal bleeding and hemorrhagic strokes outweigh any potential benefit. “Among the more than 16,000 deaths each year linked to bleeding…,about one-third of those deaths occur in those who take low-dose (81-mg) aspirin.” The FDA in 2014 warned against widespread use of aspirin in people of average risk.

Aspirin also causes stomach ulcers in 13% of those using it. And these ulcers usually develop without any warning symptoms. Many of these ulcers will cause a serious stomach bleed at some point. Also, taking low-dose aspirin on a regular basis more than doubles your risk of developing wet macular degeneration. On the positive side, people regularly taking low-dose aspirin have a significantly lower chance of getting cancer. But according to Dr. Randall S. Stafford of Stanford, “no one should take daily, low-dose aspirin solely for the purpose of preventing cancer.”

When is aspirin appropriate? Aspirin is recommended for “secondary” prevention of cardiovascular disease such as to prevent reoccurrence of a stroke or heart attack. Aspirin significantly reduces the risk for a second heart attack or stroke.

Disclaimer: the authors of this Web site are not medical doctors and are not affiliated with any medical school or organization. The information on this site is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health professional prior to starting any new treatment or with any questions you may have regarding a medical condition. Nothing contained in this service is intended to be for medical diagnosis or treatment.